NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 651:

  The healthcare team determines that an elderly client has had progressive changes in memory over the last 2 years that have interfered with her personal, social, or occupational functioning. Her memory, learning, attention, and judgment have all been affected in some way. These symptoms describe which of the following conditions?

  A. Dementia
  B. Parkinsonism
  C. Delirium
  D. Mania
  A. Dementia

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  (A) These changes are common characteristics of dementia. (B) Parkinson's disease affects the muscular system. Progressive memory changes are not presenting symptoms. (C) Delirium includes an altered level of consciousness, which is not found in dementia. (D) Mania includes symptoms of hyperactivity, flight of ideas, and delusions of grandeur.

• Question 652:

  A client is pleased about being pregnant, yet states, "It is really not the best time, but I guess it will be OK." The nurse's assessment of this response is:

  A. Initial maternal-infant bonding may be poor.
  B. Client may have a poor relationship with her husband.
  C. This response is normal in the first trimester.
  D. This response is abnormal, to be re-evaluated at the next visit.
  C. This response is normal in the first trimester.

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  (A) Ambivalence is normal during the first trimester. Reva Rubin addresses the issue of "not now" in the first trimester. The statement still leaves room for exploration. (B) There are no data to support this. This statement by the mother still leaves room for exploration. (C) Ambivalenceis normal during the first trimester. Reva Rubin addresses the issue of "not now." This fact should be shared with the mother during further exploration of the comment. (D) It is not abnormal. If it were, another month would also be too long to wait.

• Question 653:

  When administering phenytoin (Dilantin) to a child, the nurse should be aware that a toxic effect of phenytoin therapy is:

  A. Stephens-Johnson syndrome
  B. Folate deficiency
  C. Leukopenic aplastic anemia
  D. Granulocytosis and nephrosis
  A. Stephens-Johnson syndrome

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  (A) Stephens-Johnson syndrome is a toxic effect of phenytoin. (B) Folate deficiency is a side effect of phenytoin, but not a toxic effect. (C) Leukopenic aplastic anemia is a toxic effect of carbamazepine (Tegretol). (D) Granulocytosis and nephrosis are toxic effects of trimethadione (Tridione).

• Question 654:

  The pediatrician has diagnosed tinea capitis in an 8- year-old girl and has placed her on oral griseofulvin. The nurse should emphasize which of these instructions to the mother and/or child?

  A. Administer oral griseofulvin on an empty stomach for best results.
  B. Discontinue drug therapy if food tastes funny.
  C. May discontinue medication when the child experiences symptomatic relief.
  D. Observe for headaches, dizziness, and anorexia.
  D. Observe for headaches, dizziness, and anorexia.

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  (A) Giving the drug with or after meals may allay gastrointestinal discomfort. Giving the drug with a fatty meal (ice cream or milk) increases absorption rate. (B) Griseofulvin may alter taste sensations and thereby decrease the appetite. Monitoring of food intake is important, and inadequate nutrient intake should be reported to the physician. (C) The child may experience symptomatic relief after 48?6 hours of therapy. It is important to stress continuing the drug therapy to prevent relapse (usually about 6 weeks). (D) The incidence of side effects is low; however, headaches are common. Nausea, vomiting, diarrhea, and anorexia may occur. Dizziness, although uncommon, should be reported to the physician.

• Question 655:

  A 74-year-old female client is 3 days postoperative. She has an indwelling catheter and has been progressing well. While the nurse is in the room, the client states, "Oh dear, I feel like I have to urinate again!" Which of the following is the most appropriate initial nursing response?

  A. Assure her that this is most likely the result of bladder spasms.
  B. Check the collection bag and tubing to verify that the catheter is draining properly.
  C. Instruct her to do Kegel exercises to diminish the urge to void.
  D. Ask her if she has felt this way before.
  B. Check the collection bag and tubing to verify that the catheter is draining properly.

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  (A) Although this may be an appropriate response, the initial response would be to assure the patency of the catheter. (B) The most frequent reason for an urge to void with an indwelling catheter is blocked tubing. This response would be the best initial response. (C) Kegel exercises while a retention catheter is in place would not help to prevent a voiding urge and could irritate the urethral sphincter. (D) Though the nurse would want to ascertain whether the client has felt the same urge to void before, the initial response should be to assure the patency of the catheter.

• Question 656:

  A client is a depressed, 48-year-old salesman. A serious concern for the nurse working with depressed clients is the potential of suicide. The time that suicide is most likely to occur is:

  A. In the acutely depressed state
  B. When the depression starts to lift
  C. In the denial phase
  D. During a manic episode
  B. When the depression starts to lift

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  (A) The client may be too disorganized in the acute phase to make a workable plan. (B) When the depression starts to lift, the client is able to make a workable plan. (C) There usually is not a significant denial phase related to depression. Suicide occurs in a state of despair and hopelessness. (D) Suicide is uncommon in the manic state. In this state, clients do not feel hopeless, but euphoric and overly confident.

• Question 657:

  During an examination, the nurse notes that an infant has diaper rash on the convex surfaces of his buttocks, inner thighs, and scrotum. Which of the following nursing interventions will be most effective in resolving the condition?

  A. Coating the inflamed areas with zinc oxide
  B. Using talcum powder on the inflamed areas to promote drying
  C. Removing the diaper entirely for extended periods of time
  D. Cleaning the inflamed area thoroughly with disposable wet "wipes" at each diaper change
  C. Removing the diaper entirely for extended periods of time

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  (A) Zinc oxide is not usually applied to inflamed areas because it contributes to sweat retention. (B) Talcum powder is of questionable benefit and poses a hazard of accidental inhalation. (C) Removing the diaper and exposing the area to air and light facilitate drying and healing. (D) Infants may be sensitive to one or more agents in the wet "wipes." It is better to simply clean with a wet cloth.

• Question 658:

  A 23-year-old borderline client is admitted to an inpatient psychiatric unit following an impulsive act of self-mutilation. A few hours after admission, she requests special privileges, and when these are not granted, she stands up and angrily shouts that the people on the unit do not care, and she storms across the room. The nurse should respond to this behavior by:

  A. Placing her in seclusion until the behavior is under control
  B. Walking up to the client and touching her on the arm to get her attention
  C. Communicating a desire to assist the client to regain control, offering a one-to-one session in a quiet area
  D. Confronting the client, letting her know the consequences for getting angry and disrupting the unit
  C. Communicating a desire to assist the client to regain control, offering a one-to-one session in a quiet area

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  (A)

  Threatening a client with punitive action is violating a client's rights and could escalate the client's anger. (B) Angry clients need respect for personal space, and physical contact may be perceived as a threatening gesture escalating anger.

  (C)

  Client lacks sufficient self- control to limit own maladaptive behavior; she may need assistance from staff. (D) Confronting an angry client may escalate her anger to further acting out, and consequences are for acting out anger aggressively, not for getting angry or feeling angry.

• Question 659:

  The nurse should know that according to current thinking, the most important prognostic factor for a client with breast cancer is:

  A. Tumor size
  B. Axillary node status
  C. Client's previous history of disease
  D. Client's level of estrogen-progesterone receptor assays
  B. Axillary node status

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  (A) Although tumor size is a factor in classification of cancer growth, it is not an indicator of lymph node spread. (B) Axillary node status is the most important indicator for predicting how far the cancer has spread. If the lymph nodes are positive for cancer cells, the prognosis is poorer. (C) The client's previous history of cancer puts her at an increased risk for breast cancer recurrence, especially if the cancer occurred in the other breast. It does not predict prognosis, however. (D) The estrogen-progesterone assay test is used to identify present tumors being fedfrom an estrogen site within the body. Some breast cancers grow rapidly as long as there is an estrogen supply such as from the ovaries. The estrogen-progesterone assay test does not indicate the prognosis.

• Question 660:

  A 20-year-old female client delivers a stillborn infant. Following the delivery, an appropriate response by the labor nurse to the question, "Why did this happen to my baby?" is:

  A. "It's God's will. It was probably for the best. There was something probably wrong with your baby."
  B. "You're young. You can have other children later."
  C. "I know your other children will be a great comfort to you."
  D. "I can see you're upset. Would you like to see and hold your baby?"
  D. "I can see you're upset. Would you like to see and hold your baby?"

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  (A) The mother and the father require support; the nurse should not minimize their grief in this situation. (B) Attachment to this infant occurs during the pregnancy for both the mother and father. Another child cannot replace this child. (C) Attachment to this infant occurs during the pregnancy for both the mother and father. Siblings will not replace their feelings or minimize their loss of this infant. (D) Holding and viewing the infant decreases denial and may facilitate the grief process. The nurse should prepare family members for how the infant appears ("she is bruised") and provide support.